Representatives Bill Cassidy (R-LA), Michael Honda (D-CA), Hank Johnson (D-GA), and Barbara Lee (D-CA) are taking a leadership role in responding to the U.S. Preventive Services Task Force’s disappointing draft “C” recommendation for testing Baby Boomers for hepatitis C. They are circulating a sign-on letter among their colleagues that urges the USPSTF to change the grade to an “A” or a “B” when it finalizes its recommendations (see letter below).

This letter is an extremely important tool in convincing the USPSTF to improve its grade. We need as many House Representatives as possible to sign this letter. Please take a few minutes to call your Representative and ask him/her to sign!

How you can help:

Please call your House Representative’s Washington, DC office as soon as possible, and before January 4, 2013 (the deadline for signing the letter).

Ask to speak with the staffperson who handles health care issues. Whether you leave a voicemail or speak with the staffperson live, tell him/her: “My name is ____________ and I live in (city). I am calling to urge Representative _____________ to sign the bi-partisan letter by Representatives Cassidy, Honda, Johnson, and Lee that urges the U.S. Preventive Services Task Force to improve its recommended “C” grade for hepatitis C testing. We need a stronger USPSTF recommendation in order to identify the millions of Americans who have hepatitis C and don’t know it.

If you have questions about the letter, or wish to sign, please contact A.J. Bhadelia in Representative Honda’s office, Scott Goldstein in Representative Johnson’s office, or Robb Walton in Representative Cassidy’s office.”

You can reach your House Representative through the Capitol Switchboard, (202) 224-3121. Thank you for taking the time to make a difference!

Dear Colleague, Please join us in writing a bi-partisan letter to the U.S. Preventative Services Taskforce (USPSTF) encouraging them to change their recommended “C” grade for hepatitis C (HCV) screening among baby boomers. As you may know, earlier this year, the Centers for Disease Control and Prevention (CDC) released new HCV screening guidelines recommending that providers offer the screening to anyone born in this birth cohort. The recommended grade of a “C” from the USPSTF falls disconcertingly short of meaningfully implementing the CDC’s recommendation. The USPSTF states that there is only a “small benefit” for testing those who do not have symptoms, despite the fact that HCV can remain asymptomatic for years.

CDC took an important first step in changing the testing paradigm around HCV for the better and improving health outcomes for millions of Americans. CDC’s guidelines are based on a systematic review of a comprehensive body of evidence, evidence such as age-based methods that we encourage the USPSTF to use to align itself more closely with the CDC’s recommendations. Of additional concern is the fact that the USPSTF does not have a consistent public definition for the “C” grade. While a “C” recommendation appears to put the decision to screen in the hands of the individual physician, the USPSTF notes that the “C” statement is “undergoing revision.” This could create a significant level of confusion as physicians determine how to incorporate the recommendation into practice.

It is critical we prioritize the identification of HCV-infected baby boomers in order to meet the goals of the Department of Health and Human Services’ Viral Hepatitis Action Plan. Of the estimated 3.2 million persons living with HCV, 45 to 85 percent remain unaware of their infection and are not linked to the life-saving care and treatment that are needed to avoid progression to liver disease, cirrhosis or liver cancer. Persons born between 1945 and1965 have the greatest risk for HCV related morbidity and mortality, and therefore, would see the greatest benefit from HCV screening.

We write to you on behalf of the more than 5.3 million people living with viral hepatitis in the United States, a large portion of whom remain unaware of their infection, to encourage you to change your recommended “C” grade for hepatitis C (HCV) screening among baby boomers. While we applaud the Task Force for the “B” grade recommendation for HCV testing of persons who inject drugs (PWID) and other persons with identified risks for infection as a step forward, we fear that a “C” grade recommendation for baby boomers will fail to identify a large portion of HCV-infected individuals.

We appreciate the work that the United States Preventative Services Task Force (USPSTF) does and understand the systematic review of many comprehensive bodies of evidence; however, it is critical that we prioritize the identification of HCV-infected baby boomers in order to meet the goals of the Department of Health and Human Services’ Viral Hepatitis Action Plan. Of the estimated 3.2 million persons living with HCV, 45 to 85 percent remain unaware of their infection and are not linked to the life-saving care and treatment that are needed to avoid progression to liver disease, cirrhosis or liver cancer. Persons born between 1945 and1965 have the greatest risk for HCV related morbidity and mortality, and therefore, would see the greatest benefit from HCV screening.

As you know, earlier this year, the Centers for Disease Control and Prevention (CDC) released new HCV screening guidelines recommending that providers offer the screening to anyone born in this birth cohort. The recommended grade of a “C” falls disconcertingly short of meaningfully implementing the CDC’s recommendation. The USPSTF states that there is only a “small benefit” for testing those who do not have symptoms, despite the fact that HCV can remain asymptomatic for years. Of additional concern is the fact that the USPSTF does not have a consistent public definition for the “C” grade. While a “C” recommendation appears to put the decision to screen in the hands of the individual physician, the USPSTF notes that the “C” statement is “undergoing revision.” This could create a significant level of confusion as physicians determine how to incorporate the recommendation into practice.

CDC took an important first step in changing the testing paradigm around HCV for the better and improving health outcomes for millions of Americans. CDC’s guidelines are based on a systematic review of a comprehensive body of evidence, evidence that we encourage the USPSTF to use to align itself more closely with the CDC’s recommendations. Make no mistake, failure to change this recommended grade will affect millions of Americans who will not be screened by their providers because there is no reimbursement mechanism for C grade recommendations.

The USPSTF took a major step forward by endorsing risk-based screening for people with histories of injection drug use, the leading cause of new infections today. However, history shows that risk-based screening recommendations, while perhaps theoretically most cost effective, are not most effective in practice. For example, the early recommendations for hepatitis B viral (HBV) immunization for neonates were originally risk-based for infants born to known HBV carriers, offspring of Asian and Pacific Islanders, or of mothers with known risk factors. This recommendation was so poorly followed that it was changed to universal neonatal immunization. After this is when HBV prevalence began to fall.

Another reason to support an age-based cohort recommendation, as opposed to a risk-based recommendation, is that a significant percent of hepatitis C infected patients do not know or else deny risk factors for hepatitis C. Yet another reason is that primary care physicians do not routinely inquire as to if a patient has a history of intravenous drug use. In any of these cases, the decision to test is not triggered. An age-based cohort recommendation addresses these issues. We are aware that USPTF uses literature based review in their assigning of a grade. We ask that the literature related to the greater effectiveness of age-based methods be utilized as well. Although a risk based recommendation is clearly the more intellectually elegant and theoretically cost effective, the reality is that it is only effective for those in whom risk is adequately ascertained, resulting in an extremely narrow impact.

An A or B grade recommendation can have a substantial impact on expanding screening access to millions of people living with HCV who do not know their status, bringing more people into care and treatment and decreasing new HCV infections. It will also have implications for insurance coverage of HCV testing, as USPSTF grades guide reimbursement requirements for private insurers, Medicare, and Medicaid. This is especially important given that development of new therapies for HCV is advancing rapidly. Data recently presented at the annual American Association for the Study of Liver Diseases meeting suggests that highly effective, safe, short acting and all-oral treatment regimens can be expected within the next 12 to 18 months. These advances will reduce the harms of HCV, while increasing the benefits of testing, care, and treatment.

With the HCV treatment pipeline changing, new therapies achieving successful results, revised and expanded CDC guidelines, and the HHS Viral Hepatitis Action Plan that focuses on identification of people living with viral hepatitis, it is imperative that USPSTF recommendations are congruent with federal priorities and current medical knowledge. We thank you for your time and look forward to working with you in the future. If you have any questions, please contact A.J. Bhadelia with Rep. Mike Honda’s office (aj@mail.house.gov), Scott Goldstein with Rep. Johnson’s office (scott.goldstein@mail.house.gov) or Robb Walton with Rep. Cassidy’s office (robb.walton@mail.house.gov).